Auditory brain-stem, middle- and long-latency evoked potentials in mild cognitive impairment

Executive function measures of participants with mild cognitive impairment: Systematic review and meta-analysis of event-related potential studies

OBJECTIVE

Objective measurements of executive functions using event-related potential (ERP) may be used as markers for differentiating healthy controls (HC) from patients with mild cognitive impairment (MCI). ERP is non-invasive, cost-effective, and affordable. Older adults with MCI demonstrate deteriorated executive function, serving as a potentially valid neurophysiological marker for identifying MCI. We aimed to review published ERP studies on executive function in older adults with MCI and summarize the performance differences by component between healthy older adults and older adults with MCI.

METHODS

Eight electronic databases (Web of Science, PubMed, ScienceDirect, American Psychological Association PsycNet, Cochrane Library, Scopus, Embase, and Ovid) were searched for the study. Articles published from January 1 to December 31, 2022, were considered for this review. A random-effects meta-analysis and between-study heterogeneity analysis were conducted using Comprehensive Meta-Analysis V3.0 software.

RESULTS

We identified 7829 articles of which 28 met the full inclusion criteria and were included in the systematic review and analyses. Our pooled analysis suggested that participants with MCI can be differentiated from HC by significant P200, P300, and N200 latencies. The P100 and P300 amplitudes were significantly smaller in participants with MCI when compared with those in the HCs, and the patients with MCI showed increased N200 amplitudes. Our findings provide new insights into potential electrophysiological biomarkers for diagnosing MCI.

Adjunct Methods for Alzheimer's Disease Detection: A Review of Auditory Evoked Potentials

The auditory afferent pathway as a clinical marker of Alzheimer's disease (AD) has sparked interest in investigating the relationship between age-related hearing loss (ARHL) and AD. Given the earlier onset of ARHL compared to cognitive impairment caused by AD, there is a growing emphasis on early diagnosis and intervention to postpone or prevent the progression from ARHL to AD. In this context, auditory evoked potentials (AEPs) have emerged as a widely used objective auditory electrophysiological technique for both the clinical diagnosis and animal experimentation in ARHL due to their non-invasive and repeatable nature. This review focuses on the application of AEPs in AD detection and the auditory nerve system corresponding to different latencies of AEPs. Our objective was to establish AEPs as a systematic and non-invasive adjunct method for enhancing the diagnostic accuracy of AD. The success of AEPs in the early detection and prediction of AD in research settings underscores the need for further clinical application and study.

Increased central auditory gain in 5xFAD Alzheimer's disease mice as an early biomarker candidate for Alzheimer's disease diagnosis

Alzheimer's Disease (AD) is a neurodegenerative illness without a cure. All current therapies require an accurate diagnosis and staging of AD to ensure appropriate care. Central auditory processing disorders (CAPDs) and hearing loss have been associated with AD, and may precede the onset of Alzheimer's dementia. Therefore, CAPD is a possible biomarker candidate for AD diagnosis. However, little is known about how CAPD and AD pathological changes are correlated. In the present study, we investigated auditory changes in AD using transgenic amyloidosis mouse models. AD mouse models were bred to a mouse strain commonly used for auditory experiments, to compensate for the recessive accelerated hearing loss on the parent background. Auditory brainstem response (ABR) recordings revealed significant hearing loss, a reduced ABR wave I amplitude, and increased central gain in 5xFAD mice. In comparison, these effects were milder or reversed in APP/PS1 mice. Longitudinal analyses revealed that in 5xFAD mice, central gain increase preceded ABR wave I amplitude reduction and hearing loss, suggesting that it may originate from lesions in the central nervous system rather than the peripheral loss. Pharmacologically facilitating cholinergic signaling with donepezil reversed the central gain in 5xFAD mice. After the central gain increased, aging 5xFAD mice developed deficits for hearing sound pips in the presence of noise, consistent with CAPD-like symptoms of AD patients. Histological analysis revealed that amyloid plaques were deposited in the auditory cortex of both mouse strains. However, in 5xFAD but not APP/PS1 mice, plaque was observed in the upper auditory brainstem, specifically the inferior colliculus (IC) and the medial geniculate body (MGB). This plaque distribution parallels histological findings from human subjects with AD and correlates in age with central gain increase. Overall, we conclude that auditory alterations in amyloidosis mouse models correlate with amyloid deposits in the auditory brainstem and may be reversed initially through enhanced cholinergic signaling. The alteration of ABR recording related to the increase in central gain prior to AD-related hearing disorders suggests that it could potentially be used as an early biomarker of AD diagnosis.

Relationship of loudness-dependent auditory evoked potentials with change-related cortical responses

Previous studies have suggested that change-related cortical responses are phenomena similar to the onset response and could be applied to the loudness dependence of auditory evoked potential (LDAEP) paradigm. In the present study, we examined the relationship between LDAEP and the change-related response using electroencephalography findings in 50 healthy subjects. There were five conditions (55, 65, 75, 85, and 95 dB) for LDAEP and five similar conditions (abrupt sound pressure increase from 70 to 75, 80, 85, 90, and 95 dB) for the change-related response. Both the onset and abrupt sound pressure increase evoked a triphasic response with peaks at approximately 50 (P50), 100 (N100), and 200 (P200) ms. We calculated the peak-to-peak amplitudes for P50/N100 and N100/P200. Medians and slopes for P50/N100 and N100/P200 amplitudes were calculated and compared between the two measures. Results revealed a significant correlation for both the slope and median for P50/N100 (r = 0.36, 0.37, p = 1.0 × 10⁻², 7.9 × 10⁻³), N100/P200 (r = 0.40, 0.34, p = 4.0 × 10⁻³, 1.6 × 10⁻²), and P50/N100/P200 (r = 0.36, 0.35, p = 1.0 × 10⁻², 1.3 × 10⁻²). These results suggested that the change-related response and LDAEP shared generation mechanisms at least partially.

Musical experience partially counteracts temporal speech processing deficits in putative mild cognitive impairment

Mild cognitive impairment (MCI) commonly results in more rapid cognitive and behavioral declines than typical aging. Individuals with MCI can exhibit impaired receptive speech abilities that may reflect neurophysiological changes in auditory-sensory processing prior to usual cognitive deficits. Benefits from current interventions targeting communication difficulties in MCI are limited. Yet, neuroplasticity associated with musical experience has been implicated in improving neural representations of speech and offsetting age-related declines in perception. Here, we asked whether these experience-dependent effects of musical experience might extend to aberrant aging and offer some degree of cognitive protection against MCI. During a vowel categorization task, we recorded single-channel electroencephalograms (EEGs) in older adults with putative MCI to evaluate speech encoding across subcortical and cortical levels of the auditory system. Critically, listeners varied in their duration of formal musical experience (0-21 years). Musical experience sharpened temporal precision in auditory cortical responses, suggesting that musical experience produces more efficient processing of acoustic features by counteracting age-related neural delays. Additionally, robustness of brainstem responses predicted the severity of cognitive decline, suggesting that early speech representations are sensitive to preclinical stages of cognitive impairment. Our results extend prior studies by demonstrating positive benefits of musical experience in older adults with emergent cognitive impairments.

Understanding the Relationship Between Age-Related Hearing Loss and Alzheimer’s Disease: A Narrative Review

Evidence suggests that hearing loss (HL), even at mild levels, increases the long-term risk of cognitive decline and incident dementia. Hearing loss is one of the modifiable risk factors for dementia, with approximately 4 million of the 50 million cases of dementia worldwide possibly attributed to untreated HL. This paper describes four possible mechanisms that have been suggested for the relationship between age-related hearing loss (ARHL) and Alzheimer’s disease (AD), which is the most common form of dementia. The first mechanism suggests mitochondrial dysfunction and altered signal pathways due to aging as a possible link between ARHL and AD. The second mechanism proposes that sensory degradation in hearing impaired people could explain the relationship between ARHL and AD. The occupation of cognitive resource (third) mechanism indicates that the association between ARHL and AD is a result of increased cognitive processing that is required to compensate for the degraded sensory input. The fourth mechanism is an expansion of the third mechanism, i.e., the function and structure interaction involves both cognitive resource occupation (neural activity) and AD pathology as the link between ARHL and AD. Exploring the specific mechanisms that provide the link between ARHL and AD has the potential to lead to innovative ideas for the diagnosis, prevention, and/or treatment of AD. This paper also provides insight into the current evidence for the use of hearing treatments as a possible treatment/prevention for AD, and if auditory assessments could provide an avenue for early detection of cognitive impairment associated with AD.

The electrophysiological masking level difference: effects of age and mediation of hearing and cognition

OBJECTIVE

Evaluate the conceptual framework that age effects on the electrophysiological binaural masking level difference (MLD) are partially mediated by age-related hearing loss and/or global cognitive function via mediation analysis.

DESIGN

Participants underwent a series of audiometric tests. The MLD was measured via cortical auditory evoked potentials using a speech stimulus (/ɑ/) in speech-weighted background noise. We used mediation analyses to determine the total effect, natural direct effects, and natural indirect effects, which are displayed as regression coefficients ([95% CI]; p value).

STUDY SAMPLE

Twenty-eight individuals aged 19-87 years (mean [SD]: 53.3 [25.2]), recruited from the community.

RESULTS

Older age had a significant total effect on the MLD (-0.69 [95% CI: -0.96, -0.45]; p < 0.01). Neither pure tone average (-0.11 [95% CI: -0.43, 0.24; p = 0.54] nor global cognitive function (-0.02 [95% CI: -0.13, 0.02]; p = 0.55) mediated the relationship of age and the MLD and effect sizes were small. Results were insensitive to use of alternative hearing measures or inclusion of interaction terms.

CONCLUSIONS

The electrophysiological MLD may be an age-sensitive measure of binaural temporal processing that is minimally affected by age-related hearing loss and global cognitive function.

Acupuncture for amnestic mild cognitive impairment: A pilot multicenter, randomized, parallel controlled trial

INTRODUCTION

Patients with amnesic mild cognitive impairment (aMCI) are more likely to develop Alzheimer disease than corresponding age normal population. Because Alzheimer disease is irreversible, early intervention for aMCI patients seems important and urgent. We have designed a pilot multicenter, randomized, parallel controlled trial to assess the efficacy and safety of acupuncture on aMCI, explore the feasibility of acupuncture in the treatment of aMCI, so as to provide a reference for large-sample clinical trials in the next stage.

METHOD

We designed a pilot multicenter, randomized, parallel controlled trial. This trial aims to test the feasibility of carrying out a large-sample clinical trial. In this trial, 50 eligible patients with aMCI will be included and allocated to acupuncture group (n = 25) or sham acupuncture group (n = 25) at random. Subjects will accept treatment 2 times a week for 12 weeks continuously, with a total of 24 treatment sessions. We will select 6 acupoints (GV20, GV14, bilateral BL18, bilateral BL23). For the clinical outcomes, the primary outcome is Montreal cognitive assessment, which will be assessed from baseline to the end of this trial. And the secondary outcomes are Mini-mental State Examination, Delayed Story Recall, Clinical Dementia Rating scale, Global Deterioration Scale, Activity of Daily Life, Alzheimer Disease Assessment Scale-Cognitive Section, brain magnetic resonance imaging, brain functional magnetic resonance imaging, and event-related potential P300, which will be assessed before and after treatment. In addition, we will assess the safety outcomes from baseline to the end of this trial and feasibility outcome after treatment. We will evaluate neuropsychological assessment scale (Montreal cognitive assessment, Mini-mental State Examination, Alzheimer Disease Assessment Scale-Cognitive Section) at 3 months and 6 months after treatment.

DISCUSSION

This pilot trial aims to explore the feasibility of the trial, verify essential information of its efficacy and safety. This pilot study will provide a preliminary basis for carrying out a larger clinical trial of acupuncture on aMCI in near future.

Early Functional and Cognitive Declines Measured by Auditory-Evoked Cortical Potentials in Mice With Alzheimer's Disease

Alzheimer’s disease (AD) is characterized by a progressive loss of memory and cognitive decline. However, the assessment of AD-associated functional and cognitive changes is still a big challenge. Auditory-evoked cortical potential (AECP) is an event-related potential reflecting not only neural activation in the auditory cortex (AC) but also cognitive activity in the brain. In this study, we used the subdermal needle electrodes with the same electrode setting as the auditory brainstem response (ABR) recording and recorded AECP in normal aging CBA/CaJ mice and APP/PS1 AD mice. AECP in mice usually appeared as three positive peaks, i.e., P1, P2, and P3, and three corresponding negative peaks, i.e., N1, N2, and N3. In normal aging CBA mice, the early sensory peaks P1, N1, and P2 were reduced as age increased, whereas the later cognitive peaks N2, P3, and N3 were increased or had no changes with aging. Moreover, the latency of the P1 peak was increased as age increased, although the latencies of later peaks had a significant reduction with aging. In AD mice, peak P1 was significantly reduced in comparison with wild-type (WT) littermates at young ages, proceeding AD phenotype presentation. In particular, the later cognitive peak P3 was diminished after 3 months old, different from the normal aging effect. However, the latencies of AECP peaks in AD mice generally had no significant delay or changes with aging. Finally, consistent with AECP changes, the accumulation of amyloid precursor protein (APP) at the AC was visible in AD mice as early as 2 months old. These data suggest that AECP could serve as an early, non-invasive, and objective biomarker for detecting AD and AD-related dementia (ADRD).

Head Injury Exposure in Veterans Presenting to Memory Disorders Clinic: An Observational Study of Clinical Characteristics and Relationship of Event-Related Potentials and Imaging Markers

Objective: Traumatic brain injury (TBI) and repetitive head impacts (RHI) related to blasts or contact sports are commonly reported among military service members. However, the clinical implications of remote TBI and RHI in veterans remains a challenge when evaluating older veterans at risk of neurodegenerative conditions including Alzheimer's disease (AD) and Chronic Traumatic Encephalopathy (CTE). This study aimed to test the hypothesis that veterans in a memory disorders clinic with remote head injury would be more likely to have neurodegenerative clinical diagnoses, increased rates of amyloid PET positivity, higher prevalence of cavum septum pellucidi/vergae, and alterations in event-related potential (ERP) middle latency auditory evoked potentials (MLAEPs) and long latency ERP responses compared to those without head injuries. Methods: Older veterans aged 50-100 were recruited from a memory disorders clinic at VA Boston Healthcare system with a history of head injury (n = 72) and without head injury history (n = 52). Patients were classified as reporting prior head injury including TBI and/or RHI exposure based on self-report and chart review. Participants underwent MRI to determine presence/absence of cavum and an ERP auditory oddball protocol. Results: The head injury group was equally likely to have a positive amyloid PET compared to the non-head injury group. Additionally, the head injury group were less likely to have a diagnosis of a neurodegenerative condition than those without head injury. P200 target amplitude and MLAEP amplitudes for standard and target tones were decreased in the head injury group compared to the non-head injury group while P3b amplitude did not differ. Conclusions: Veterans with reported remote head injury evaluated in a memory disorders clinic were not more likely to have a neurodegenerative diagnosis or imaging markers of neurodegeneration than those without head injury. Decreased P200 target and MLAEP target and standard tone amplitudes in the head injury group may be relevant as potential diagnostic markers of remote head injury.

Event-Related Potential Measures of the Passive Processing of Rapidly and Slowly Presented Auditory Stimuli in MCI

Much research effort is currently devoted to the development of a simple, low-cost method to determine early signs of Alzheimer’s disease (AD) pathology. The present study employs a simple paradigm in which event-related potentials (ERPs) were recorded to a single auditory stimulus that was presented rapidly or very slowly while the participant was engaged in a visual task. A multi-channel EEG was recorded in 20 healthy older adults and 20 people with mild cognitive impairment (MCI). In two different conditions, a single 80 dB sound pressure level (SPL) auditory stimulus was presented every 1.5 s (fast condition) or every 12.0 s (slow condition). Participants were instructed to watch a silent video and ignore the auditory stimuli. Auditory processing thus occurred passively. When the auditory stimuli were presented rapidly (every 1.5 s), N1 and P2 amplitudes did not differ between the two groups. When the stimuli were presented very slowly, the amplitude of N1 and P2 increased in both groups and their latencies were prolonged. The amplitude of N1 did not significantly differ between the two groups. However, the subsequent positivity was reduced in people with MCI compared to healthy older adults. This late positivity in the slow condition may reflect a delayed P2 or a summation of a composite P2 + P3a. In people with MCI, the priority of processing may not be switched from the visual task to the potentially much more relevant auditory input. ERPs offer promise as a means to identify the pathology underlying cognitive impairment associated with MCI.

A Meta-Analysis of Brain DNA Methylation Across Sex, Age, and Alzheimer's Disease Points for Accelerated Epigenetic Aging in Neurodegeneration

Alzheimer's disease (AD) is characterized by specific alterations of brain DNA methylation (DNAm) patterns. Age and sex, two major risk factors for AD, are also known to largely affect the epigenetic profiles in brain, but their contribution to AD-associated DNAm changes has been poorly investigated. In this study we considered publicly available DNAm datasets of four brain regions (temporal, frontal, entorhinal cortex, and cerebellum) from healthy adult subjects and AD patients, and performed a meta-analysis to identify sex-, age-, and AD-associated epigenetic profiles. In one of these datasets it was also possible to distinguish 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) profiles. We showed that DNAm differences between males and females tend to be shared between the four brain regions, while aging differently affects cortical regions compared to cerebellum. We found that the proportion of sex-dependent probes whose methylation is modified also during aging is higher than expected, but that differences between males and females tend to be maintained, with only a few probes showing age-by-sex interaction. We did not find significant overlaps between AD- and sex-associated probes, nor disease-by-sex interaction effects. On the contrary, we found that AD-related epigenetic modifications are significantly enriched in probes whose DNAm varies with age and that there is a high concordance between the direction of changes (hyper or hypo-methylation) in aging and AD, supporting accelerated epigenetic aging in the disease. In summary, our results suggest that age-associated DNAm patterns concur to the epigenetic deregulation observed in AD, providing new insights on how advanced age enables neurodegeneration.

Cognitive performance and long-latency auditory evoked potentials: a study on aging

OBJECTIVE

To evaluate the relationship between cognitive performance and long-latency auditory evoked potentials in an elderly population.

METHODS

The sample consisted of adults between 20 and 58 years of age and elderly adults between 60 and 70 years of age. The screening procedures adopted were an inspection of the external auditory canal, tonal and vocal audiometry, tympanometry, brain stem auditory evoked potential, the Montreal Cognitive Assessment test, and long-latency auditory evoked potential.

RESULTS

The latency and amplitude values of cortical components by age group showed significant differences under the following conditions: (i) signals evoked by the speech stimulus /da/ and by the pure-tone stimulus at 2,000 Hz for the N2 amplitude (p=0.008 and p=0.001, respectively) , which were both higher for adults, and (ii) signals evoked by the speech stimulus /da/ for N1 latency (p=0.018) and by the pure-tone stimulus at 2,000 Hz for P2 latency (p=0.017), which were both higher in the elderly population. The cognitive component (P300) showed a significant difference when evoked by speech stimuli, with higher latency in the elderly population (p=0.013). When correlated with cognitive processes, the latency and amplitude of cortical potentials showed direct and medium-strength correlations between abnormal scores obtained on the Montreal Cognitive Assessment test and P2 amplitude (p<0.001 and r=0.452).

CONCLUSION

There is a relationship between long-latency potentials and cognitive performance in the elderly, which was observed by the increase in the P2 amplitude and the impairment of the process of sound decoding.

Investigating Auditory Electrophysiological Measures of Participants with Mild Cognitive Impairment and Alzheimer's Disease: A Systematic Review and Meta-Analysis of Event-Related Potential Studies

BACKGROUND

Objectively measuring auditory functions has been proposed as an avenue in differentiating normal age-related cognitive dysfunction from Alzheimer's disease (AD) and its prodromal states. Previous research has suggested auditory event-related potentials (AERPs) to be non-invasive, cost-effective, and efficient biomarkers for the diagnosis of AD.

OBJECTIVE

The objective of this paper is to review the published literature on AERPs measures in older adults diagnosed with AD and those at higher risk of developing AD, i.e., mild cognitive impairment (MCI) and subjective cognitive decline.

METHODS

The search was performed on six major electronic databases (Ovid MEDLINE, OVID EMBASE, PsycINFO, PubMed, Scopus, and CINAHL Plus). Articles identified prior to 7 May 2019 were considered for this review. A random effects meta-analysis and analysis of between study heterogeneity was conducted using the Comprehensive Meta-Analysis software.

RESULTS

The search identified 1,076 articles; 74 articles met the full inclusion criteria and were included in the systematic review, and 47 articles were included into the analyses. Pooled analysis suggests that AD participants can be differentiated from controls due to significant delays in ABR, N100, P200, N200, and P300 latencies. P300 amplitude was significantly smaller in AD participants compared to controls. P300 latencies differed significantly between MCI participants and controls based on the pooled analysis.

CONCLUSION

The findings of this review indicate that some AERPs may be valuable biomarkers of AD. In conjunction with currently available clinical and neuropsychological assessments, AERPs can aid in screening and diagnosis of prodromal AD.

Inefficient resource allocation is associated with reduced alpha activity in parietal regions in individuals with Parkinson's disease

The brain's ability to act as an input filter and to suppress actions is crucial to navigate everyday life and impairments in these abilities affect quality of life substantially. Although Parkinson's disease (PD) is primarily known as a movement disorder, recent research has redefined it as a multisystem disorder affecting cognition, in particular inhibitory control and attentional resource allocation. Analysing the neural mechanisms underlying this cognitive deficit provides a better understanding of brain changes observed in patients affected by PD. Therefore, this study aimed to identify resource allocation to relevant and irrelevant stimuli in patients affected by PD. Besides neuropsychological tests, we employed electroencephalographic recordings during an auditory oddball paradigm in 13 patients suffering from idiopathic PD and 11 healthy controls (HC). Participants were instructed to ignore the standard stimulus and to respond as fast as possible to the rarely presented target tone. Event-related potentials (ERP) and time-frequency representations (TFR) were analyzed. Patients affected by PD showed faster response latencies to the task-irrelevant standard tones, but slower response latencies to target tones compared to HC. This observation was prominent at frontal sites during later P3-like processing stages. Reaction time, however, was prolonged in patients with PD, suggesting inefficient resource allocation. Additionally, TFR revealed reduced parietal alpha activity, which is associated with distractor suppression and functional inhibition in patients with PD compared to healthy controls. Thus, our results point towards inefficient resource allocation in patients with PD possibly driven by less functional inhibition through parietal alpha activity.

Hearing loss is an early biomarker in APP/PS1 Alzheimer's disease mice

Alzheimer's disease (AD) is a neurodegenerative disease characterized by a progressive loss of memory and cognitive decline. Over the last decade, it has been found that defects in sensory systems could be highly associated with AD. Hearing is an important neural sense. However, little is known about hearing functional changes in AD. In this study, APP/PS1 AD mice (Jackson Lab: Stack No. 004462) were used. Hearing function was assessed by auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), and cochlear microphonics (CM) recordings. Wild-type (WT) littermates served as control. We found that APP/PS1 AD mice measured as ABR threshold had hearing loss. The hearing loss appeared at high frequency as early as 2 months old, prior to the reported occurrence of spatial learning deficit at 6-7 months of age in this AD mouse model. The hearing loss was progressive and extended from high frequency to low frequency. At 3-4 months old, the hearing loss appeared in the whole-frequency range. Moreover, the wave IV and V in the super-threshold ABR were eliminated, indicating substantial impairment in inferior colliculus, nuclei of lateral lemniscus, and medial geniculate body in the upper brainstem. DPOAE in APP/PS1 AD mice was also reduced. However, there was no reduction in CM in APP/PS1 mice. These data demonstrate that unlike age-related hearing loss APP/PS1 AD mice have early onset of hearing loss. These data also suggest that hearing function testing could provide a simple, sensitive, non-invasive screen-tool for early detecting AD and localizing lesion.

Cortical auditory evoked potentials in mild cognitive impairment: Evidence from a temporal-spatial principal component analysis

Mild cognitive impairment (MCI) is considered an intermediate transitional stage for the development of dementia, especially Alzheimer's disease. The identification of neurophysiological biomarkers for MCI will allow improvement in detecting and tracking the progression of cognitive impairment. The primary objective of this study was to compare cortical auditory evoked potentials between older adults with and without probable MCI to identify potential neurophysiological indicators of cognitive impairment. We applied a temporal-spatial principal component analysis to the evoked potentials achieved during the processing of pure tones and speech sounds, to facilitate the separation of the components of the P1-N1-P2 complex. The probable MCI group showed a significant amplitude increase in a factor modeling N1b for speech sounds (Cohen's d = .84) and a decrease in a factor around the P2 time interval, especially for pure tones (Cohen's d = 1.17). Moreover, both factors showed a fair discrimination value between groups (area under the curve [AUC] = .698 for N1b in speech condition; AUC = .746 for P2 in tone condition), with high sensitivity to detect MCI cases (86% and 91%, respectively). The results for N1b suggest that MCI participants may suffer from a deficit to inhibit irrelevant speech information, and the decrease of P2 amplitude could be a signal of cholinergic hypoactivation. Therefore, both components could be proposed as early biomarkers of cognitive impairment.

Auditory system dysfunction in Alzheimer disease and its prodromal states: A review

Recent findings suggest that both peripheral and central auditory system dysfunction occur in the prodromal stages of Alzheimer Disease (AD), and therefore may represent early indicators of the disease. In addition, loss of auditory function itself leads to communication difficulties, social isolation and poor quality of life for both patients with AD and their caregivers. Developing a greater understanding of auditory dysfunction in early AD may shed light on the mechanisms of disease progression and carry diagnostic and therapeutic importance. Herein, we review the literature on hearing abilities in AD and its prodromal stages investigated through methods such as pure-tone audiometry, dichotic listening tasks, and evoked response potentials. We propose that screening for peripheral and central auditory dysfunction in at-risk populations is a low-cost and effective means to identify early AD pathology and provides an entry point for therapeutic interventions that enhance the quality of life of AD patients.

MEG biomarker of Alzheimer's disease: Absence of a prefrontal generator during auditory sensory gating

Magnetoencephalography (MEG), a direct measure of neuronal activity, is an underexplored tool in the search for biomarkers of Alzheimer's disease (AD). In this study, we used MEG source estimates of auditory gating generators, nonlinear correlations with neuropsychological results, and multivariate analyses to examine the sensitivity and specificity of gating topology modulation to detect AD. Our results demonstrated the use of MEG localization of a medial prefrontal (mPFC) gating generator as a discrete (binary) detector of AD at the individual level and resulted in recategorizing the participant categories in: (1) controls with mPFC generator localized in response to both the standard and deviant tones; (2) a possible preclinical stage of AD participants (a lower functioning group of controls) in which mPFC activation was localized to the deviant tone only; and (3) symptomatic AD in which mPFC activation was not localized to either the deviant or standard tones. This approach showed a large effect size (0.9) and high accuracy, sensitivity, and specificity (100%) in identifying symptomatic AD patients within a limited research sample. The present results demonstrate high potential of mPFC activation as a noninvasive biomarker of AD pathology during putative preclinical and clinical stages. Hum Brain Mapp 38:5180-5194, 2017. © 2017 Wiley Periodicals, Inc.

Effect of Mild Cognitive Impairment and Alzheimer Disease on Auditory Steady-State Responses

INTRODUCTION

Mild Cognitive Impairment (MCI), a disorder of the elderly people, is difficult to diagnose and often progresses to Alzheimer Disease (AD). Temporal region is one of the initial areas, which gets impaired in the early stage of AD. Therefore, auditory cortical evoked potential could be a valuable neuromarker for detecting MCI and AD.

METHODS

In this study, the thresholds of Auditory Steady-State Response (ASSR) to 40 Hz and 80 Hz were compared between Alzheimer Disease (AD), MCI, and control groups. A total of 42 patients (12 with AD, 15 with MCI, and 15 elderly normal controls) were tested for ASSR. Hearing thresholds at 500, 1000, and 2000 Hz in both ears with modulation rates of 40 and 80 Hz were obtained.

RESULTS

Significant differences in normal subjects were observed in estimated ASSR thresholds with 2 modulation rates in 3 frequencies in both ears. However, the difference was significant only in 500 Hz in the MCI group, and no significant differences were observed in the AD group. In addition, significant differences were observed between the normal subjects and AD patients with regard to the estimated ASSR thresholds with 2 modulation rates and 3 frequencies in both ears. A significant difference was observed between the normal and MCI groups at 2000 Hz, too. An increase in estimated 40 Hz ASSR thresholds in patients with AD and MCI suggests neural changes in auditory cortex compared to that in normal ageing.

CONCLUSION

Auditory threshold estimation with low and high modulation rates by ASSR test could be a potentially helpful test for detecting cognitive impairment.

Noise and pitch interact during the cortical segregation of concurrent speech

Behavioral studies reveal listeners exploit intrinsic differences in voice fundamental frequency (F0) to segregate concurrent speech sounds-the so-called "F0-benefit." More favorable signal-to-noise ratio (SNR) in the environment, an extrinsic acoustic factor, similarly benefits the parsing of simultaneous speech. Here, we examined the neurobiological substrates of these two cues in the perceptual segregation of concurrent speech mixtures. We recorded event-related brain potentials (ERPs) while listeners performed a speeded double-vowel identification task. Listeners heard two concurrent vowels whose F0 differed by zero or four semitones presented in either clean (no noise) or noise-degraded (+5 dB SNR) conditions. Behaviorally, listeners were more accurate in correctly identifying both vowels for larger F0 separations but F0-benefit was more pronounced at more favorable SNRs (i.e., pitch × SNR interaction). Analysis of the ERPs revealed that only the P2 wave (∼200 ms) showed a similar F0 x SNR interaction as behavior and was correlated with listeners' perceptual F0-benefit. Neural classifiers applied to the ERPs further suggested that speech sounds are segregated neurally within 200 ms based on SNR whereas segregation based on pitch occurs later in time (400-700 ms). The earlier timing of extrinsic SNR compared to intrinsic F0-based segregation implies that the cortical extraction of speech from noise is more efficient than differentiating speech based on pitch cues alone, which may recruit additional cortical processes. Findings indicate that noise and pitch differences interact relatively early in cerebral cortex and that the brain arrives at the identities of concurrent speech mixtures as early as ∼200 ms.

Mild Cognitive Impairment Is Characterized by Deficient Brainstem and Cortical Representations of Speech

Mild cognitive impairment (MCI) is recognized as a transitional phase in the progression toward more severe forms of dementia and is an early precursor to Alzheimer's disease. Previous neuroimaging studies reveal that MCI is associated with aberrant sensory-perceptual processing in cortical brain regions subserving auditory and language function. However, whether the pathophysiology of MCI extends to speech processing before conscious awareness (brainstem) is unknown. Using a novel electrophysiological approach, we recorded both brainstem and cortical speech-evoked brain event-related potentials (ERPs) in older, hearing-matched human listeners who did and did not present with subtle cognitive impairment revealed through behavioral neuropsychological testing. We found that MCI was associated with changes in neural speech processing characterized as hypersensitivity (larger) brainstem and cortical speech encoding in MCI compared with controls in the absence of any perceptual speech deficits. Group differences also interacted with age differentially across the auditory pathway; brainstem responses became larger and cortical ERPs smaller with advancing age. Multivariate classification revealed that dual brainstem-cortical speech activity correctly identified MCI listeners with 80% accuracy, suggesting its application as a biomarker of early cognitive decline. Brainstem responses were also a more robust predictor of individuals' MCI severity than cortical activity. Our findings suggest that MCI is associated with poorer encoding and transfer of speech signals between functional levels of the auditory system and advance the pathophysiological understanding of cognitive aging by identifying subcortical deficits in auditory sensory processing mere milliseconds (<10 ms) after sound onset and before the emergence of perceptual speech deficits.SIGNIFICANCE STATEMENT Mild cognitive impairment (MCI) is a precursor to dementia marked by declines in communication skills. Whether MCI pathophysiology extends below cerebral cortex to affect speech processing before conscious awareness (brainstem) is unknown. By recording neuroelectric brain activity to speech from brainstem and cortex, we show that MCI hypersensitizes the normal encoding of speech information across the hearing brain. Deficient neural responses to speech (particularly those generated from the brainstem) predicted the presence of MCI with high accuracy and before behavioral deficits. Our findings advance the neurological understanding of MCI by identifying a subcortical biomarker in auditory-sensory processing before conscious awareness, which may be a precursor to declines in speech understanding.

Cognitive Event-Related Potentials in Patients With Adenoid Hypertrophy: A Case-Control Pilot Study

PURPOSE

Children with adenoid hypertrophy commonly have sleep-disordered breathing. Sleep-disordered breathing is associated with various neurocognitive problems. The aim of this study was to assess the cognitive function in those patients using cognitive event-related potentials.

METHODS

Twenty-three patients with moderate to severe adenoid hypertrophy were compared with 20 healthy controls. The intelligence quotient was performed for all study participants. The latencies of the N200, P300 peaks and the amplitudes of the N200/P300 components of event-related potentials were recorded. The above variables were measured at baseline for both patients and control groups and 2 months after adenoidectomy for the patient group.

RESULTS

There was no significant difference between patients and controls regarding full intelligence quotient scales. P300 latency was significantly prolonged in patient group compared with the healthy controls. Moreover, postoperative P300 latency was significantly reduced compared with the preoperative P300 latency. Postoperative P300 latency was not statistically different from healthy controls' data.

CONCLUSIONS

P300 latency delay may reflect some sort of cognitive impairment in patients with adenoid hypertrophy. This delay was reversible after adenoidectomy. Event-related potentials may help for assessment of cognitive functions in patients with adenoid hypertrophy.

Mechanisms of the Hearing-Cognition Relationship

This review provides a description of age-related changes in hearing and cognition, the relationship between hearing and cognition, and several potential mechanisms that underlie the relationship. Several studies have shown a significant relationship between peripheral hearing loss and cognitive impairment/decline but other studies have not. Furthermore, poor performance on measures of central auditory processing has been significantly associated with cognitive impairment. Important to understanding these relationships are the nature of the underlying mechanisms. Possible mechanisms are overdiagnosis, widespread neural degeneration, sensory degradation/deprivation, cognitive resource allocation/depletion, and social isolation/depression. Overdiagnosis occurs when hearing loss impacts tests of cognitive function or vice versa. Widespread neural degeneration can impact hearing, cognition, or both. Sensory degradation/deprivation due to hearing loss can result in neural degradation and reduced cognitive function. Increased demands due to hearing loss can result in changes in neural resource allocation, reducing available resources for cognitive function. Finally, hearing difficulties can cause social isolation and even depression, increasing the risk for cognitive decline. Data from our laboratory provide support for cognitive resource allocation/depletion. Understanding all five of these mechanisms will advance the development of effective interventions and treatments, thereby enhancing the quality of life of older adults.

The role of P300 event-related potentials in the cognitive recovery after the stroke

The aim of this study was to elucidate the effects of an ischemic stroke on the amplitude and latency of the P300 wave and evaluate their changes over a prospective 1-year follow-up period. We recorded the P300 wave using an auditory oddball paradigm in 60 consecutive brain infarct patients at baseline (i.e., within 4 weeks after the stroke), after 3 months, after 12 months and in 30 healthy control subjects. The P300 latencies in stroke patients were significantly longer and the P300 amplitudes were significantly smaller than those of the control group. The latency of P300 showed a highly significant average improvement 12 months after the stroke compared to the baseline. There was no significant change observed for the P300 amplitude during the same period. The P3 latency is initially more increased in the patients with hemispheric brain infarction but shows a better recovery compared to the patients with brainstem infarction. Also, the results of the P300 latency of patients with the left-sided lesions was significantly longer compared to the patients with right-sided lesions on the beginning of the study but not 3 and 12 months after the stroke. The results of our study show the importance of P300 event-related potentials in the detection and follow-up of cognitive changes after ischemic stroke.

Functional changes in inter- and intra-hemispheric cortical processing underlying degraded speech perception

Previous studies suggest that at poorer signal-to-noise ratios (SNRs), auditory cortical event-related potentials are weakened, prolonged, and show a shift in the functional lateralization of cerebral processing from left to right hemisphere. Increased right hemisphere involvement during speech-in-noise (SIN) processing may reflect the recruitment of additional brain resources to aid speech recognition or alternatively, the progressive loss of involvement from left linguistic brain areas as speech becomes more impoverished (i.e., nonspeech-like). To better elucidate the brain basis of SIN perception, we recorded neuroelectric activity in normal hearing listeners to speech sounds presented at various SNRs. Behaviorally, listeners obtained superior SIN performance for speech presented to the right compared to the left ear (i.e., right ear advantage). Source analysis of neural data assessed the relative contribution of region-specific neural generators (linguistic and auditory brain areas) to SIN processing. We found that left inferior frontal brain areas (e.g., Broca's areas) partially disengage at poorer SNRs but responses do not right lateralize with increasing noise. In contrast, auditory sources showed more resilience to noise in left compared to right primary auditory cortex but also a progressive shift in dominance from left to right hemisphere at lower SNRs. Region- and ear-specific correlations revealed that listeners' right ear SIN advantage was predicted by source activity emitted from inferior frontal gyrus (but not primary auditory cortex). Our findings demonstrate changes in the functional asymmetry of cortical speech processing during adverse acoustic conditions and suggest that "cocktail party" listening skills depend on the quality of speech representations in the left cerebral hemisphere rather than compensatory recruitment of right hemisphere mechanisms.

P50: A candidate ERP biomarker of prodromal Alzheimer's disease

INTRODUCTION

Reductions of cerebrospinal fluid (CSF) amyloid-beta (Aβ42) and elevated phosphorylated-tau (p-Tau) reflect in vivo Alzheimer's disease (AD) pathology and show utility in predicting conversion from mild cognitive impairment (MCI) to dementia. We investigated the P50 event-related potential component as a noninvasive biomarker of AD pathology in non-demented elderly.

METHODS

36 MCI patients were stratified into amyloid positive (MCI-AD, n=17) and negative (MCI-Other, n=19) groups using CSF levels of Aβ42. All amyloid positive patients were also p-Tau positive. P50s were elicited with an auditory oddball paradigm.

RESULTS

MCI-AD patients yielded larger P50s than MCI-Other. The best amyloid-status predictor model showed 94.7% sensitivity, 94.1% specificity and 94.4% total accuracy.

DISCUSSION

P50 predicted amyloid status in MCI patients, thereby showing a relationship with AD pathology versus MCI from another etiology. The P50 may have clinical utility for inexpensive pre-screening and assessment of Alzheimer's pathology.

Musical training orchestrates coordinated neuroplasticity in auditory brainstem and cortex to counteract age-related declines in categorical vowel perception

Musicianship in early life is associated with pervasive changes in brain function and enhanced speech-language skills. Whether these neuroplastic benefits extend to older individuals more susceptible to cognitive decline, and for whom plasticity is weaker, has yet to be established. Here, we show that musical training offsets declines in auditory brain processing that accompanying normal aging in humans, preserving robust speech recognition late into life. We recorded both brainstem and cortical neuroelectric responses in older adults with and without modest musical training as they classified speech sounds along an acoustic-phonetic continuum. Results reveal higher temporal precision in speech-evoked responses at multiple levels of the auditory system in older musicians who were also better at differentiating phonetic categories. Older musicians also showed a closer correspondence between neural activity and perceptual performance. This suggests that musicianship strengthens brain-behavior coupling in the aging auditory system. Last, "neurometric" functions derived from unsupervised classification of neural activity established that early cortical responses could accurately predict listeners' psychometric speech identification and, more critically, that neurometric profiles were organized more categorically in older musicians. We propose that musicianship offsets age-related declines in speech listening by refining the hierarchical interplay between subcortical/cortical auditory brain representations, allowing more behaviorally relevant information carried within the neural code, and supplying more faithful templates to the brain mechanisms subserving phonetic computations. Our findings imply that robust neuroplasticity conferred by musical training is not restricted by age and may serve as an effective means to bolster speech listening skills that decline across the lifespan.

Towards an optimal paradigm for simultaneously recording cortical and brainstem auditory evoked potentials

BACKGROUND

Simultaneous recording of brainstem and cortical event-related brain potentials (ERPs) may offer a valuable tool for understanding the early neural transcription of behaviorally relevant sounds and the hierarchy of signal processing operating at multiple levels of the auditory system. To date, dual recordings have been challenged by technological and physiological limitations including different optimal parameters necessary to elicit each class of ERP (e.g., differential adaptation/habitation effects and number of trials to obtain adequate response signal-to-noise ratio).

NEW METHOD

We investigated a new stimulus paradigm for concurrent recording of the auditory brainstem frequency-following response (FFR) and cortical ERPs. The paradigm is "optimal" in that it uses a clustered stimulus presentation and variable interstimulus interval (ISI) to (i) achieve the most ideal acquisition parameters for eliciting subcortical and cortical responses, (ii) obtain an adequate number of trials to detect each class of response, and (iii) minimize neural adaptation/habituation effects.

RESULTS AND COMPARISON WITH EXISTING METHOD

Comparison between clustered and traditional (fixed, slow ISI) stimulus paradigms revealed minimal change in amplitude or latencies of either the brainstem FFR or cortical ERP. The clustered paradigm offered over a 3× increase in recording efficiency compared to conventional (fixed ISI presentation) and thus, a more rapid protocol for obtaining dual brainstem-cortical recordings in individual listeners.

CONCLUSIONS

We infer that faster recording of subcortical and cortical potentials might allow more complete and sensitive testing of neurophysiological function and aid in the differential assessment of auditory function.

Coordinated plasticity in brainstem and auditory cortex contributes to enhanced categorical speech perception in musicians

Musicianship is associated with neuroplastic changes in brainstem and cortical structures, as well as improved acuity for behaviorally relevant sounds including speech. However, further advance in the field depends on characterizing how neuroplastic changes in brainstem and cortical speech processing relate to one another and to speech-listening behaviors. Here, we show that subcortical and cortical neural plasticity interact to yield the linguistic advantages observed with musicianship. We compared brainstem and cortical neuroelectric responses elicited by a series of vowels that differed along a categorical speech continuum in amateur musicians and non-musicians. Musicians obtained steeper identification functions and classified speech sounds more rapidly than non-musicians. Behavioral advantages coincided with more robust and temporally coherent brainstem phase-locking to salient speech cues (voice pitch and formant information) coupled with increased amplitude in cortical-evoked responses, implying an overall enhancement in the nervous system's responsiveness to speech. Musicians' subcortical and cortical neural enhancements (but not behavioral measures) were correlated with their years of formal music training. Associations between multi-level neural responses were also stronger in musically trained listeners, and were better predictors of speech perception than in non-musicians. Results suggest that musicianship modulates speech representations at multiple tiers of the auditory pathway, and strengthens the correspondence of processing between subcortical and cortical areas to allow neural activity to carry more behaviorally relevant information. We infer that musicians have a refined hierarchy of internalized representations for auditory objects at both pre-attentive and attentive levels that supplies more faithful phonemic templates to decision mechanisms governing linguistic operations.

Cholinergic gating of hippocampal auditory evoked potentials in freely moving rats

As perturbations in auditory filtering appear to be a candidate trait marker of schizophrenia, there has been considerable interest in the development of translational rat models to elucidate the underlying neural and neurochemical mechanisms involved in sensory gating. This is the first study to investigate the effects of the non-selective muscarinic antagonist scopolamine, the muscarinic M1 antagonist biperiden and the cholinesterase inhibitor donepezil (also in combination with scopolamine and biperiden) on auditory evoked potentials (AEPs) and sensory gating. In the saline condition, only the N50 peak displayed sensory gating. Scopolamine and biperiden both disrupted sensory gating by increasing N50 amplitude for the S2 click. Donepezil was able to fully reverse the effects of biperiden on N50 sensory gating, but had residual effects when combined with scopolamine; i.e., it enhanced sensory gating by increasing N50 amplitude of the S1 stimulus. Donepezil by itself improved sensory gating by enhancing N50 amplitude of S1, and reducing N50 amplitude of the S2 click. In conclusion, due to its relatively more selective effects biperiden is to be preferred over scopolamine as a means for pharmacologically inducing cholinergic impairments in auditory processing in healthy rats. Changes in auditory processing and sensory gating induced by cholinergic drugs may serve as a translational model for aging instead of schizophrenia.

Cholinergic modulation of auditory processing, sensory gating and novelty detection in human participants

RATIONALE

Suppression of redundant auditory information and facilitation of deviant, novel, or salient sounds can be assessed with paired-click and oddball tasks, respectively. Electrophysiological correlates of perturbed auditory processing found in these paradigms are likely to be a trait marker or candidate endophenotype for schizophrenia.

OBJECTIVE

This is the first study to investigate the effects of the muscarinic M1 antagonist biperiden and the cholinesterase inhibitor rivastigmine on auditory-evoked potentials (AEPs), sensory gating, and mismatch negativity (MMN) in young, healthy volunteers.

RESULTS

Biperiden increased P50 amplitude and prolonged N100 and P200 latency in the paired-click task but did not affect sensory gating. Rivastigmine was able to reverse the effects of biperiden on N100 and P200 latency. Biperiden increased P50 latency in the novelty oddball task, which was reversed by concurrent administration of rivastigmine. Rivastigmine shortened N100 latency and enhanced P3a amplitude in the novelty oddball paradigm, both of which were reversed by biperiden.

CONCLUSION

The muscarinic M1 receptor appears to be involved in preattentive processing of auditory information in the paired-click task. Additional effects of biperiden versus rivastigmine were reversed by a combination treatment, which renders attribution of these findings to muscarinic M1 versus muscarinic M2-M5 or nicotinic receptors much more difficult. It remains to be seen whether the effects of cholinergic drugs on AEPs are specifically related to the abnormalities found in schizophrenia. Alternatively, aberrant auditory processing could also be indicative of a general disturbance in neural functioning shared by several neuropsychiatric disorders and/or neurodegenerative changes seen in aging.

Vagus somatosensory evoked potentials--a possibility for diagnostic improvement in patients with mild cognitive impairment?

OBJECTIVE

Vagus somatosensory evoked potentials (VSEP) are far-field potentials probably generated in nuclei of then. vagus in the lower brainstem. They represent a putative, easily applicable method for discrimination between patients with Alzheimer's disease (AD), patients with mild cognitive impairment (MCI), and healthy controls (HC).

METHODS

Thirteen patients with AD, 12 with MCI, and 27 age- and gender-matched HC were investigated by stimulating the cutaneous branch of the n. vagus; 8, 6, and 20, respectively, were included in the main part of the analysis.

RESULTS

In fronto-central recordings (electrode positions Fz-F4) a grading from HC over MCI to AD could be found, with a significant linear trend over the three groups and significantly increased latencies of the cognitively impaired patients but no significant difference between MCI and AD.

CONCLUSION

The results indicate that the method of VSEP is able to discriminate between cognitively declined patients and HC, whereas no clear-cut differences were detected between MCI and AD.

Event-related potentials for the diagnosis of mild cognitive impairment and Alzheimer's disease

INTRODUCTION

Alzheimer's disease (AD) and the nosological entity of mild cognitive impairment (MCI) constitute a major public health concern. The diagnostic approach and therapeutic management of these disorders may be significantly improved by recent advances in the field of event-related potentials (ERPs).

AREAS COVERED

The authors performed a PubMed search in order to identify full-length, original research articles on the experimental and clinical application of ERPs in AD and MCI. The major part of the retrieved articles concerns the application of auditory and, to a lesser extent, visual ERPs for the early diagnosis of AD and MCI. Particular emphasis was placed on the role of ERPs in identifying the subgroup of MCI patients who will subsequently convert to AD. Other areas covered include the contribution of ERPs in the differential diagnosis of dementia types, the utility of ERPs for monitoring pharmacological treatment in AD and the correlation between ERPs and the results of neuropsychological testing.

EXPERT OPINION

The reviewed evidence suggests that ERPs hold promise as an electrophysiological tool for the early and accurate diagnosis of AD and MCI. However, certain methodological issues need to be resolved before ERPs enter the arena of clinical practice.

The level of arousal modulates P50 peak amplitude

We aimed to evaluate the effect of arousal level in healthy subjects on P50 potential, as the variation in the level of arousal may be a source of variance in the recordings as well as it may provide additional information about the pathology under study. Eleven healthy volunteers participated in the study. A standard auditory P50 potential paradigm was applied. Two stimulation conditions were selected: eyes-open, i.e., high arousal level condition and eyes-closed, i.e., low arousal level condition. P50 component amplitudes in response to both the first (S1) and second stimulus (S2) of the pair, their ratio and difference were evaluated. P50 amplitude in response to S1 was significantly higher during the low arousal closed eyes condition as compared to high arousal open eyes condition. There was no P50 amplitude difference in response to S2 and no arousal effect on gating measures. This prompts for more careful evaluation of patients' arousal level when performing P50 studies and interpreting the results.

Cortical event-related potentials in preclinical familial Alzheimer disease

OBJECTIVE

To define changes in cortical function in persons inheriting familial Alzheimer disease (FAD) mutations before the onset of cognitive decline.

METHODS

Twenty-six subjects with a family history of FAD were divided into 2 subgroups according to genotype (FAD mutation carriers, n = 15; FAD noncarriers, n = 11). Subjects were given standardized tests of cognitive function and the Clinical Dementia Rating scale (CDR). Sensory (P50, N100, P200) and cognitive (N200, P300) event-related potentials were recorded during an auditory discrimination task. Amplitudes and latencies of cortical potentials were compared among FAD mutation carriers and noncarriers.

RESULTS

FAD mutation carriers and noncarriers did not significantly differ in age or on measures of cognitive function, but FAD carriers had a greater incidence of 0.5 CDR scores (1/10 noncarriers, 5/15 carriers). Relative to noncarriers, FAD mutation carriers had significantly longer latencies of the N100, P200, N200, and P300 components, and smaller slow wave amplitudes. Subanalyses of subjects having CDR scores of 0.0 also showed latency increases in FAD mutation carriers.

CONCLUSIONS

Auditory sensory and cognitive cortical potentials in persons with familial Alzheimer disease (FAD) mutations are abnormal approximately 10 years before dementia will be manifest. Longer event-related potential latencies suggest slowing of cortical information processing in FAD mutation carriers.

Usefulness of event-related potentials in the assessment of mild cognitive impairment

Background

The aim of this study was to determine if changes in latencies and amplitudes of the major waves of Auditory Event-Related Potentials (AERP), correlate with memory status of patients with mild cognitive impairment (MCI) and conversion to Alzheimer's disease (AD).

91 patients with MCI (mean ± SD age = 66.6 ± 5.4, MMSE score = 27.7) and 30 age-matched healthy control (AMHC) subjects (mean ± SD age = 68.9 ± 9.9) were studied. 54 patients were re-examined after an average period of 14(± 5.2) months. During this time period 5 patients converted to AD. Between-group differences in latency and amplitude of the major AERP waves (N200, P300 and Slow Wave) were determined. Within each group, correlation coefficients (CC) between these characteristics of the different AERP waves were calculated. Finally, for patients, CCs were determined among each AERP wave and their age and MMSE scores. Confirmatory factor analysis (CFA) was used to examine the underlying structure of waveforms both in the control and the patient groups.

Results

Latencies of all major AERP components were prolonged in patients compared to controls. Patients presented with significantly higher N200 amplitudes, but no significant differences were observed in P300 amplitudes. Significant differences between follow-up and baseline measurements were found for P300 latency (p = 0.009), N200 amplitude (p < 0.001) and P300 amplitude (p = 0.05). MMSE scores of patients did not correlate with latency or amplitude of the AERP components. Moreover, the establishment of a N200 latency cut-off value of 287 ms resulted in a sensitivity of 100% and a specificity of 91% in the prediction of MCI patients that converted to AD.

Conclusion

Although we were not able to establish significant correlations between latencies and amplitudes of N200, P300 and SW and the patients' performance in MMSE, which is a psychometric test for classifying patients suffering from MCI, our results point out that the disorganization of the AERP waveform in MCI patients is a potential basis upon which a neurophysiologic methodology for identifying and "staging" MCI can be sought. We also found that delayed N200 latency not only identifies memory changes better than the MMSE, but also may be a potential predictor of the MCI patients who convert to AD.

P50 gating deficit in Alzheimer dementia correlates to frontal neuropsychological function

BACKGROUND

Cognitive inhibition processes were found to be deficient early in the clinical course of Alzheimer's disease (AD). The inhibition of redundant information is a precondition for efficient cognitive processing and presumably modulated by prefrontal attentional networks. Deficits in the suppression of the evoked potential P50 response to paired clicks are well known in schizophrenic patients and undergo cholinergic modulation. In this study, we aimed to investigate inhibitory gating deficits of P50 in AD and their relation to neuropsychological measures.

METHOD

P50 suppression was assessed in 19 AD-patients in comparison to a young and elderly control group (n=17 each) and related to MMSE and specific neuropsychological assessments.

RESULTS

Patients showed reduced sensory gating compared to healthy elderly (p<0.021) and exhibited significantly higher N40-P50-amplitudes. There were no age or gender effects in controls. Frontal neuropsychological tests (TMT-B, verbal fluency) and working memory requiring inhibition, but not declarative memory functions, were significantly correlated with inhibitory gating and test amplitude in both, AD-patients and controls.

CONCLUSIONS

The results support an early inhibitory deficit interfering with executive functions and working memory in AD independent from physiological aging. P50 gating might be applicable as a marker for inhibition deficits and thereby be important for prognosis estimation.